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Can geometry-based parameters from pQCT and material parameters from quantitative ultrasound (QUS) improve the prediction of radial bone strength over that by bone mass (DXA)?

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Abstract

The diagnosis of osteoporosis is generally based on the assessment of bone mineral content with dual X-ray absorptiometry (DXA) but does not account for the spatial distribution and inherent material properties of the tissue. Peripheral quantitative computed tomography (pQCT) permits one to measure the compartment-specific density and geometry-based parameters of cortical bone. Quantitative ultrasound (QUS) parameters are associated with material properties of cortical bone. The purpose of this study was to test the hypothesis that pQCT and cortical QUS provide additional information to DXA in predicting structural strength of the distal radius. The intact right arm and the isolated left radius were harvested from 70 formalin-fixed cadavers (age 79±11 years). The bone mineral content (BMC) was assessed with DXA at the radial metaphysis and shaft. pQCT was also used at the metaphysis and the shaft, while QUS was employed only at the shaft. The failure loads of the radius were assessed by use of a 3-point bending test (isolated radius) and a complex fall simulation (intact arm). The BMC (DXA) displayed a correlation of r=0.96 with the failure moments in 3-point bending (P<0.001). The correlation between failure load and geometry-based parameters (pQCT) ranged from r=0.85 to r=0.96 and was r=0.64 for the speed of sound (QUS) (P <0.001). Cortical thickness (pQCT) improved the prediction marginally (r=0.964) in combination with DXA. For the fall simulation, the correlation coefficients were r=0.76 for BMC (DXA) of the shaft, r=0.83 for metaphyseal bone content (pQCT), r=0.55 for QUS, and ranged from r=0.59 to r=0.74 for geometry-based parameters at the shaft (pQCT). pQCT and QUS parameters provided no significant improvement versus DXA alone. Measurement of bone mass by DXA or pQCT thus appears to be sufficient as a surrogate of mechanical strength and fracture risk of the distal radius.

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Acknowledgements

We would like to thank Stratec Medizintechnik (Pforzheim, Germany) for providing the XCT 2000 pQCT scanner and Sunlight Medical GmbH, Europe (Ravensburg, Germany) for providing the Omnisense ultrasound system (Omnisense 7000). Gudrun Goldmann is to be thanked for her help with the ultrasound and DXA measurements and Dr. Stephan Metz for his help with obtaining the radiographs of the forearms after mechanical testing.

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Authors and Affiliations

  1. Musculoskeletal Research Group, Institute of Anatomy, LMU München, Pettenkoferstrasse 11, 80336, Munich, Germany

    M. Hudelmaier, V. Kuhn, H. Well & F. Eckstein

  2. Institute of Anatomy, Paracelsus Private Medical University, Salzburg, Austria

    M. Hudelmaier, V. Kuhn, H. Well & F. Eckstein

  3. 1st Gynaecology Hospital, LMU München, Munich, Germany

    E. M. Lochmüller

  4. Department of Trauma Surgery, Hamburg University School of Medicine, Hamburg, Germany

    M. Priemel

  5. Department of Radiology, Technische Universität München, Munich, Germany

    T. M. Link

Authors
  1. M. Hudelmaier
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  2. V. Kuhn
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  3. E. M. Lochmüller
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  4. H. Well
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  5. M. Priemel
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  6. T. M. Link
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  7. F. Eckstein
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Corresponding author

Correspondence to M. Hudelmaier.

Additional information

M. Hudelmaier and V. Kuhn contributed equally to this study

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Hudelmaier, M., Kuhn, V., Lochmüller, E.M. et al. Can geometry-based parameters from pQCT and material parameters from quantitative ultrasound (QUS) improve the prediction of radial bone strength over that by bone mass (DXA)?. Osteoporos Int 15, 375–381 (2004). https://doi.org/10.1007/s00198-003-1551-8

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  • DOI: https://doi.org/10.1007/s00198-003-1551-8

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